Should parents lose custody of obese children?

Some of the most difficult ethical questions I encountered in my Medical Ethics rotation involved parents making poor health choices for their children. When parents’ own beliefs contradict those of the health care providers, the medical team must weigh the parental rights to make decisions for their child against “doing no harm” to the pediatric patient.

One of these situations in particular fascinates me: when children are severely obese, and the parents are unable or unwilling to help the child lose weight. Obesity is as much a form of malnutrition as underfeeding children. Either way, the kids are not receiving the proper nutrients they need to thrive. Severe childhood obesity can be life-threatening, and not just years in the future due to diabetes, high blood pressure, and heart disease that may develop as an adult. For example, these children can become so obese that their respiratory status is compromised because of sleep apnea, when children temporarily stop breathing during sleep. In cases like these, should Child Protective Services be called to evaluate for medical neglect?

One paper I read argues that if the child’s health is in imminent danger due to obesity and there are effective treatments that the state can provide, removal from the home should be considered. It seems extreme, but severe childhood obesity is a growing problem that pediatricians may face more and more in the future. What are your thoughts? Is it ever justified to remove severely obese children from the home to help them lose weight?